Healthcare Provider Details

I. General information

NPI: 1154291623
Provider Name (Legal Business Name): TIERA AUSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 GUARDIAN CT
ROCKY MOUNT NC
27804-3017
US

IV. Provider business mailing address

1214 BUXTON RD NW
WILSON NC
27896-2094
US

V. Phone/Fax

Practice location:
  • Phone: 252-212-3350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5023515
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: